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Family centred care: illusion, rhetoric or reality?
Mälardalen University, School of Health, Care and Social Welfare. (CHILD)ORCID iD: 0000-0001-6163-9690
Trinity university, Ireland.
2008 (English)In: 10th International Paediatric and Child Health Nursing Conference 30/4-2/5 2008 Darwin, Australia: Crossing Barriers, 2008Conference paper, Published paper (Refereed)
Abstract [en]

Overview of symposium

Family centred care has been promoted as the ideal way to structure the nursing care of sick children and their families and is seen as a key principle in children’s health care provision globally. The involvement of parents in the delivery of care is seen as leading to positive outcomes both for the child and family. Although parent participation has been promoted for several decades, been formalised in numerous government policy documents, and embraced by health professionals in hospital and community, it remains a difficult concept to operationalise. There is discrepancy between what is espoused and what is actually practiced. There is confusion about the concept and inconsistent application in practice in hospital and community healthcare settings. The purpose of this symposium is to present a considered critique of family centred care which will be of use to practitioners and educators and which will provide a forum for debate and collegiality. The key objectives are:

1. To highlight the idealised notion of FCC and challenge current assumptions of FCC.

2. To contrast the idealised version with reality, drawing on our research (experiences from England, Sweden, Mozambique, Australia, Indonesia, Thailand) to substantiate the content

3. To discuss how FCC is about survival, obligation or choice.

4. To suggest ways in which FCC may be implemented to provide a firmer basis for development and evaluation of practice.

The symposium will consist of four related presentations that focus on family centred care and with the opportunity for participants to make both written feedback/response to the papers and to join in a discussion with the presenters.

Presentation 1: ‘The elephant in the room?’ Professor Bernie Carter

Family centred care is part of our psyche, part of our professional raison d’être. Children’s nurses are not actually born hard-wired to believe in family-centred care but the wiring is laid down early in our education and its centrality to our way of working and being with families continues to be emphasised. However, there is a paradox at the heart of FCC: we all believe that it is good but there is no ‘hard’ evidence (and not much ‘soft’ evidence) that demonstrates that it is effective. Despite this we ‘know’ that it is good, we promulgate it as a way of working – perhaps because we can’t think of anything else that’s better. In this paper, Bernie intends to problematise and question our faith in FCC and provide a stepping off point for my fellow presenters’ papers.

Presentation 2. Professor Imelda Coyne

The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. Imelda will illustrate how parents want to stay with their hospitalised child (in varying ways) primarily because of concern for their child’s welfare but then feel compelled to be there because of nurses’ expectations. Nurses controlled the nature of parents’ participation and parents had to ‘toe the line’. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When certain parents did not adhere to these norms, they caused disruption to the order and routine of the ward. The dominant process appeared to be the socialisation of parents to their role on the ward through inclusionary and exclusionary tactics. The results from this research (from UK & Ireland) indicate that the current models or theories on parent participation/ partnership are inappropriate or inadequate because they do not address important elements of children and parents’ experiences in hospital. The impact of the burden of caring and providing a consistent presence on parents and their families could be considerable and adversely affect parents’ welfare in the long term.

Presentation 3 Dr Maja Soderback

Maja will illustrate how participation or mutuality are co-created by nurses and the involved family caregivers during a child’s hospitalization. The situated actions are culture bound and different professional cultures struggle with tradition of family caregivers’ involvement as well as different work conditions. Maja will draw on data from two studies (from Sweden and Mozambique) to provide insights into the nurses’ mastering of their everyday encounters with family caregivers during a child’s hospitalization. The studies used ethnography with participant observations and interviews. The fieldwork in Sweden occurred at three paediatric wards. One or more caregivers from a family were living-in with their children 0-18 years with various illnesses. Five paediatric wards were included in Mozambique. The age of the hospitalized children varied between 0-7 years, with various illnesses. All children mostly had one family caregiver living-in with them. The conclusions demonstrate how a nurse interacts with family caregivers, and how he or she must be focused on intention and action in a specific situation, context and culture of life, and work conditions. Also important are the nurse’s beliefs about what constitutes both nursing and parenting, and the rights of children.

Presentation 4. Professor Linda Shields and Dr Jan Pratt

There are myths and misconceptions about family-centred care, and Linda and Jan will “bust” some of these based on work in developing countries. Also, they will describe the Cochrane systematic review of FCC that they undertook, explaining the inclusion and exclusion criteria for studies and the rationale behind them. The aim was to find studies that might show whether or not FCC really works. The results showed that at this stage, there is no evidence either way. From this, they will postulate that families' experiences of FCC are driven by survival, obligation or choice, and add this to the mix of discussion that will be an important part of this seminar.

Conclusion and Discussion. Professor Bernie Carter

In conclusion, Bernie will synthesise the core concepts presented in each of the four papers. These concepts will act as triggers for the discussion with the symposium participants with the aim of trying to further our understanding of FCC.

Place, publisher, year, edition, pages
2008.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-3134OAI: oai:DiVA.org:mdh-3134DiVA, id: diva2:115798
Conference
10th International Paediatric and Child Health Nursing Conference 30/4-2/5 2008 Darwin, Australia
Available from: 2008-05-08 Created: 2008-05-08 Last updated: 2013-11-13

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Söderbäck, Maja

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